Abstract

Aim

Background: Most patients with head and neck cancer (HNC) present with locally advanced disease (stage III and IV). For these patients, the prognosis is poor. Recurrence rates range between 40-60% and overall survival (OS) at 5 years is less than 20%. Although induction chemotherapy is not considered standard treatment, it has a role in irresectable tumors or in organ preservation strategy, avoiding total laryngectomy (larynx and hypofarynx cancer). The three drug regimen, adding taxane to cisplatin and fluoroucil backbone, has shown to be superior in terms of OS and progression-free survival (PFS) in several phase III studies.

Methods

Retrospective analysis of a consecutive series of patients with a new diagnosis of locally advanced HNC, with no distant metastases, treated with primary chemotherapy with TPF, from May 2010 until December 2013. After 3 cycles, the response was evaluated with a computerized tomography scan. If there was no response the treatment strategy was modified. The primary end point was OS. Survival was calculated with Kaplan-Meier method considering the time difference between the date of death or last observation and the date of the first cycle of TPF. Toxicity was classified according to Common Toxicity Criteria of Adverse Event (Version 3).

Results

A total of 143 patients were included, 93,2% were male, with a median age of 52,8 years (35-76 years). Most of the patients presented with stage IVA disease (67,8%), 19,6% with stage IVB and 12,6% with stage III. The median follow-up time was 23 months. The median overall survival was 22,5 months, with an estimated OS at 24 months of 45%. 80,4% of the patients completed 4 cycles of chemotherapy. The response rate was 70,6%, with 9,1% of total responses. Most of the patients (48,3%) were subsequently treated with concomitant chemo-radiotherapy. Mucositis was the most frequent toxicity (9%). Infection (Grade ≥3) was detected in 3,5% of the patients. The rate of death associated with toxic effects or within 30 days of last cycle was 7,6%.

Conclusions

Our survival data are comparable with the phase III studies, strengthening the role of induction chemotherapy in locally advanced head and neck cancer.